“These drugs have little benefit but are associated with potentially harmful side effects, particularly in young children,” Chua said.

“From the perspective of health care quality, the sharp decline in dispensing of cough-and-cold medications may represent a silver lining of the COVID-19 pandemic.”

While dispensing of infection-related drugs to children could rebound as social distancing measures are lifted and infections increase, it may still not necessarily return to pre-pandemic levels soon, Chua said. If COVID-19 risk–mitigation measures continue in schools and day cares, for example, this may lower the incidence of conditions for which antibiotics are frequently prescribed, such as ear infections, sinusitis and upper respiratory infections.

Dispensing of chronic disease drugs declined less sharply

The study found a modest 11% decline in dispensing of prescriptions for ADHD.

“Whether this decline is concerning needs to be studied further,” Chua said. “For example, it is unclear whether the decline in ADHD prescriptions reflect a reduced need for medications at school due to the transition to remote learning, disruptions in medication access or delays in diagnosis.”

There were also large declines in dispensing of asthma medications, such as albuterol and inhaled steroids, researchers found.

Since national data suggest that the number of asthma attacks in children has dropped sharply during the pandemic, the decline in medication dispensing likely reflects better control of asthma, Chua said.

Researchers need more data, he noted, to better understand the lack of change in antidepressant dispensing to children during the pandemic.  

“An optimistic view is that few children on established antidepressant regimens discontinued use,” Chua said. “Studies, however, suggest that the mental health of children has worsened during the pandemic, particularly among adolescents. Given this, our findings might suggest that antidepressant dispensing has not risen to meet this increased need.”  

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Clinicians may be able to use electronic health records to identify decreases in the frequency of refill requests among children on established drug regimens for chronic disease, Chua said. Providers could then call families to determine if there is a reason for concern – such as medications not being affordable for them – or if the changes reflect improved disease control.

Dispensing totals declined more sharply for prescriptions paid with cash than for other payer types. Chua said he believes that this finding may suggest that uninsured children faced greater financial-related barriers to accessing medical care and prescription drugs during the pandemic.

The decreased dispensing in kids is consistent with the drop in total number of prescriptions dispensed to adult Americans, which declined sharply during the pandemic, but subsequently rebounded. However, the study indicates dispensing to children has not rebounded to the same degree, Chua said.

“This study provides a national picture of prescription drug dispensing to children before and during the pandemic,” he said. “It will be important to monitor whether the reductions we demonstrate are temporary or sustained.”

Additional authors include Anna Volerman, M.D., from the University of Chicago and Rena M. Conti, Ph.D., from Boston Questrom University School of Business.

Study Cited: “Prescription Drug Dispensing to US Children During the COVID-19 Pandemic,” Pediatrics, DOI: 10.1542/peds.2021-049977

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